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Enhanced recovery pathways in pancreatic surgery: State of the art

World Journal of Gastroenterology 2016年第28期22卷 6456-6468页

作者： Nicolò Pecorelli Sara Nobile Stefano Partelli Luca Cardinali Stefano Crippa Gianpaolo Balzano Luigi Beretta Massimo Falconi Division of Pancreatic surgery Pancreas Translational and Clinical Research Center San Raffaele Scientific Institute "Vita-Salute" University Department of surgery Università Politecnica delle Marche Department of Anesthesiology San Raffaele Scientific Institute "Vita-Salute" University

Pancreatic surgery is being offered to an increasing number of patients every year. Although postoperative outcomes have significantly improved in the last decades, even in high-volume centers patients still experience significant postoperative morbidity and full recovery after surgery takes longer than we think. In recent years, enhanced recovery pathways incorporating a large number of evidence-based perioperative interventions have proved to be beneficial i n t e r m s o f i m p rove d p o s t o p e ra t i ve o u t c o m e s, and accelerated patient recovery in the context of gastrointestinal, genitourinary and orthopedic surgery. The role of these pathways for pancreatic surgery is still unclear as high-quality randomized controlled trials are lacking. To date, non-randomized studies have shown that care pathways for pancreaticoduodenectomy and distal pancreatectomy are safe with no difference in postoperative morbidity, leading to early discharge and no increase in hospital readmissions. Hospital costs are reduced due to better organization of care and resource utilization. However, further research is needed to clarify the effect of enhanced recovery pathways on patient recovery and post-discharge outcomes following pancreatic resection. Future studies should be prospective and follow recent recommendations for the design and reporting of enhanced recovery pathways.

关键词： pancreas surgery Perioperative care Length of stay Postoperative complications Pancreatic neoplasms Evidence-based medicine

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